Although posttransplant
nephrotic syndrome is frequent, its structural basis and prognosis have not been clearly defined. The biopsy findings of 54 patients with this disorder posttransplant, among 375 total renal transplant recipients engrafted during a 10-year period, were correlated with clinical follow-up data. The mean patient age was 41.7 +/- 12.3 years, female/male ratio 22/32, and cadaveric/living-related donor ratio 37/17. The
nephrotic syndrome developed 3 to 91 months posttransplant. At the onset the mean values of serum
creatinine was 2.9 +/- 1.8 mg/dL and
proteinuria 4.5 +/- 0.8 g/d. The index biopsy findings showed chronic allograft nephropathy (CAN) in 33; de novo
glomerulonephritis (GN) in 6, recurrent GN in 9, and undetermined GN in 6 who had an unknown primary renal disease. Among 21 follow-up biopsies during a mean of 44.3 +/- 28 months the CAN progressed but the GN remained the same. The treatment included augmented
steroids alone (n = 1) or in combination with
cyclophosphamide (n = 2) and with
plasmapheresis (n = 1);
angiotensin-converting enzyme inhibitors (ACEI) or
angiotensin receptor blockers (ARB) along (n = 5);
calcium channel blockers (CCB) alone (n = 24); or the two types of drugs together (n = 22). Complete or partial remission was achieved in 8 and 5, respectively, but
nephrotic syndrome recurred in 3 of these patients at 45.1 +/- 18 months later. Sustained remission was more likely in cases of GN (
minimal change disease and
IgA nephropathy) and ACEI-ARB treatment (P <.01). Graft failure, which occurred in 35 patients, correlated strongly with serum
creatinine at onset, being significantly greater in patients with CAN (P <.005). Both remission of the
nephrotic syndrome and graft survival were greater among patients with GN as compared to those with CAN.